Inspection on 01/08/06 for Halliwell Nursing Home

This inspection was carried out on 1st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Halliwell Nursing Home 13/09/05

Halliwell Nursing Home 24/05/05

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Halliwell Nursing Home Kingswood Road Tunbridge Wells Kent TN2 4UN Lead Inspector Mrs Ann Block Key Unannounced Inspection 1st August 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Halliwell Nursing Home Address Kingswood Road Tunbridge Wells Kent TN2 4UN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01892 525909 Elizabeth Finn Homes Ltd Mrs Gillian Forsyth Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th September 2005 Brief Description of the Service: Halliwell Nursing Home is a purpose built building on three floors dating from the 1970s with later additions. It is situated in a residential area of Tunbridge Wells a short walk from the Pantiles. There is easy access to public transport including a main line station. There is parking for staff and visitors to the front of the house. The home is in extensive grounds covering an area of up to 6 acres. Six bedrooms have their own access on to a secluded patio area. The home caters for 50 elderly and older frail service users including those who need nursing care. At the time of writing this report, fees were £985.00 per week. Residents pay the supplier directly for hairdressing, aromatherapy, chiropody, dry cleaning and newspapers Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection was carried out which included an unannounced site visit to the home on Tuesday 1st August 2006 between 9.25 am and 5.25 pm by regulatory inspector Ann Block. Residents, visitors, staff and management agreed to speak with the inspector, both in groups and privately. Three residents with high care and support needs were case tracked which normally would include speaking with the resident and looking at associated records. For differing reasons, the inspector was unable at this visit to talk directly with the residents concerned. Judgments were therefore made from observation, talking with staff and looking at supporting documentation. Feedback from the inspection was given to the Elizabeth Finn Homes Care Operations Manager and the Halliwell General Manager who both assisted the process of inspection. As part of the inspection process comment cards were received from residents, relatives and professionals. Comments about the home included: ‘Mothers health and well being has greatly improved since entering the home’ ‘I feel very fortunate to live here’ ‘Halliwell is excellent, the staff wonderful, caring and good with my father. He is much better since he went there.’ ‘An outstanding home. Very responsive to any queries or suggestions.’ ‘Halliwell is the best care home in which my wife has been cared for in the last 20 years.’ ‘I have been most impressed with the caring professional care my mother has received at the Halliwell’ A member of staff said that (in her opinion) “the home was always good but recently staff have worked hard to bring it up to excellent” The inspector is familiar with the service hence some judgements have been made combining information from previous inspections with comments from residents and staff and reflections of practice from this inspection. The report also includes information provided by the General Manager through a pre inspection questionnaire. From speaking with residents and staff it was clear that the service has at its heart the welfare of residents living at Halliwell. Systems are geared to the Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 6 needs of older people with the aim of providing the best quality of life possible within a care setting. What the service does well: What has improved since the last inspection? The General Manager and staff actively look for opportunities to develop the service and to respond to any new developments in care and health provision, good practice guidance and corporate changes. The service also actively monitors environmental standards, over the last year residents’ environment has been enhanced by the redecorating and refurbishing of many communal areas of the home and, when the opportunity presents, individual bedrooms. Improvements in response to the last inspection include that: • • • • • Short stay residents are reassured that Halliwell is right for them now that a letter is sent to them confirming that the home can meet need. Vastly improved care plans better evidence that health and personal care continues to be personalised and well managed. Residents are further protected by staff recruitment procedures as written verification of the reason for leaving work with vulnerable people is obtained. Residents’ safety is further enhanced now that every member of staff attends regular fire drills and practices. Safe administration of medication is improved now that risk assessments for self medication are more detailed, records are completed correctly in DS0000064706.V299253.R01.S.doc Version 5.2 Page 7 Halliwell Nursing Home respect of ‘as required’ medication and there is reliably safe storage of medication. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 & 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Residents and others have full provision to obtain written and practical information about Halliwell to decide whether they wish to move into the home. EVIDENCE: As soon as a prospective resident or their representative decides they might like to stay at Halliwell they will have access to a range of information about the home including a brochure and service users guide. Written information will be sent on request and is readily accessible in the entrance hall of the home. Residents or their representatives are also welcome to visit the home, talk to staff and look at the facilities Halliwell provides. A comprehensive ‘Welcome to Halliwell’ folder is placed in each bedroom. All those spoken with said they had good information about the home, families liked having information to refer to in their relatives bedroom. The General Manager ensures that information is accurate and updates documents when necessary. Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 10 Written information includes clear detail of fees and charges and of the admission criteria. The service is keen to ensure that, as far as possible, at the time of admission the home can best meet the prospective residents needs. For each such resident an experienced senior member of staff will carry out a comprehensive recorded assessment of need. As part of this assessment, staff will meet with the resident in their current place of abode such as at home or in hospital. The assessment process will include information from a range of sources. Excellent practices are carried out to ensure not only will the prospective resident feel settled in the home but that views and needs of family and friends are taken into account. Each resident will be offered a trial period to see whether they like the home and the home is right for them. To offer formal confirmation of the placement a letter is sent stating that, following assessment, the home can meet need and a contract is provided. Each resident has a contract which is comprehensive, details rights and responsibilities of both the resident and the home, and provides residents with greater security of placement. Respite care is offered as it is felt that this is a valuable service both to the older person and carers. There are no specific short stay rooms allocated, residents join in with the group. A relative said he was happy with the admission process and whilst another relative had done the bulk of the work, he was aware that the systems supported his mother settling in. He mentioned that a previous period of respite care had been an introduction to a permanent placement. Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 & 11 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Residents’ health, care and social needs are well managed and evidenced. EVIDENCE: Each resident has a plan of care which sets out a range of activities of daily living. The care plan is the underpinning documentation to promote consistent, personalised care to meet the current needs of each resident. Care plans are set up between the resident, family/representative and staff. A paper copy is held which is considered the key document and is structured to make it easily accessible. If the resident agrees, the care plan is held in their room. A database system is used as a summary record and for daily notes. A significant amount of work has been done to develop the care planning system to include social, spiritual and emotional needs in addition to care, support and health. Care plans seen were excellent. Personal touches, such as what perfume a resident likes to wear, are now included. Staff recognise the value of a comprehensive care plan and how elements link together to give a Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 12 complete picture for an individual. To ensure information is current, care plan sections are reviewed regularly and updated. Residents felt that health care provision was excellent, both in house and in obtaining further medical treatment, both private and NHS. The home has the full support of General Practitioners, Consultants and general health care services. Records of medical care confirmed that relevant risk assessments such as nutrition, tissue viability, pressure wound and falls monitoring and mobility were actively addressed. Staff realise the need to carry out a range of risk assessments and have the confidence to do so. Staff work with residents to maintain mental and physical abilities. Medication management in the home is good. Requirements and recommendations made at a pharmacy inspector’s visit have been actioned. Residents wishing to self-administer medication do so with the support of the staff within a risk management framework. Medication storage was clean, well ordered and maintained safety, including provision for controlled medication. Records were properly maintained and evidenced that medication was administered as per prescriber’s directions. There is correct accountability for medication from receipt through administration and, if necessary, disposal. Residents confirmed they were given medication at the right time. Where there are any concerns approaches are made to other health professionals. Medication reviews are carried out. The General Manager ensures that the home keeps up to date with health care, including developments in practice and equipment. Staff receive training in specialist interventions and new equipment. Residents considered that staff respected them as people with the right to privacy and dignity. Staff were seen to knock on doors. Where a room was being used for treatment such as aromatherapy, a notice is used to maintain privacy and quiet. Residents said that they were asked how they wished to be addressed and this is followed in practice. Care was taken to ensure residents continued to present themselves as they would wish. One relative had recorded in the comment book ‘I visited (name) and was so impressed at how lovely she looked, the staff I met were also so kind and caring’. Residents are aware that they will be able to remain in Halliwell throughout all stages of older age, providing their needs can continue to be met. Staff recognise that residents usually prefer to remain at Halliwell during last stages and will work with heath professionals to set out end of life care plans. Relatives are welcome to remain with the resident through the last stages of life if the resident wishes. Staff are on hand to offer both physical and emotional support. Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Residents lead a life which as closely as possible matches their preferences, beliefs and social aspirations. EVIDENCE: The statement of purpose for Halliwell clearly states the criteria for admission and the status of persons who may be accommodated there. From this there follows an expectation from residents that certain social and cultural principles will be met. From speaking with residents and from previous experience of the home, this is fully acknowledged and excellently managed. Activities and social events are arranged by a designated social and events coordinator who unfortunately was on leave during this site visit. At all previous inspections and site visits residents, visitors and staff have spoken highly of the activities coordinator, of her boundless enthusiasm and commitment to enhancing quality of life for older people. Activities are provided both on a group basis and where time allows on a one to one basis. Residents talked about a recent raspberry tea and jazz/champagne lunch. For one person this lead to an invitation to the Mayors parlour, as the resident was Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 14 formerly the mayor herself. A list of activities is displayed in the entrance hall, detailed in the daily Halliwell Times and available in large print. During the site visit the library service was due and residents brought their books to the lounge to exchange. Staff will remind residents when they are due to attend an activity. The house committee run a weekly shop. Religious preferences are identified with external and internal contacts supported. As noted during the site visit and as recorded in the visitors’ book, visitors are welcomed to the home. Provision will be made where feasible for disabled access as necessary. There are areas where meetings can take place in private. Family and friends are welcome to stay for a meal for which a small charge is made. Currently a flat can be booked for overnight stays. Residents commented how much they appreciated being able to maintain contact with family, old friends and associates. Where there is limited access to personal support, the house committee can provide friendship and advocacy. Residents felt they were able to direct their lives but as a resident has pointed out there would inevitably be restrictions in any group living situation. One person thought there was ‘no choice’ but even when not directly being observed staff were heard to offer her choices during the day. A new call system using radio pagers has been installed. Whilst this has helped the response to calls inevitably there are delays at peak times of day. Staff were aware of individual preferences and built these into daily routines as far as possible. The home uses an external contract company which covers all catering and domestic responsibilities. Food provision is based on promoting interesting, well presented, varied and seasonal foods which meets dietary needs. Choice is offered and made known each day through the ‘Halliwell Times’ with the following days menu options taken round each afternoon. Residents have use of a large dining room with areas for use by visitors and for those needing assistance. The dining room has recently been refurbished. Any assistance needed with eating is provided discreetly and on a one to one basis by care staff. Dining room staff serve and clear tables. Breakfast, tea and additional drinks are taken to individual rooms. Residents considered the food was usually very good. Encouragement is given to maintain a sound nutritional intake with records of weight maintained. Where there are concerns, more detailed records of nutrition are held in the care plan and linked to weekly weighing. Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 & 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Residents have good systems to make comment about life at Halliwell to people who can effect change and to ensure their wellbeing is protected. EVIDENCE: Residents are aware they have the right to make complaint, to be listened to and for action to be taken. How to make complaint is presented in a clear, accessible policy with contact detail, with copies placed in each room. Copies of complaint forms are also available in the hallway. Management take complaints seriously, including talking with relatives where necessary, and will ensure that their concerns are addressed with records held of the stages of the process. A communication book is made available in each room where issues can be recorded by relatives for the attention of the named nurses or keyworker. A relative felt that if issues are raised they are dealt with. By using effective communication and prompt response, action is taken to ensure minor concerns do not escalate into significant complaints. Residents have the opportunity to vote in local and national elections in person or by postal vote. All staff are required to sign that they have read the homes adult protection policy and that they will abide by principles of protecting vulnerable adults. Residents felt safe in the home and had internal and external contacts to Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 16 monitor their wellbeing. Staff receive training in adult protection procedures with two staff being POVA (Protection of Vulnerable Adults) trainers. Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents have a well maintained and decorated environment which meets their nursing and social needs. EVIDENCE: The organisation and General Manager are keen to ensure that residents have an attractive and safe place in which to live. Redecoration and repairs are carried out on a planned and responsive basis. Recent work includes redecoration of the entrance hall, dining room, some bedrooms, hallways and lounges. Residents and visitors said that one of the things that attracted them to Halliwell was the ambiance and appearance of the home. One person compared the standard of environment to a 5* hotel. A resident had recently moved bedroom, she was very happy in her new room which had an outlook over the front of the house and had been redecorated. Taking into account the range of small and larger lounges and dining spaces there is ample room for Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 18 residents to meet in small or larger groups and privately with family. Many residents enjoy being able to meet up with their friends in the dining room for lunch. Plans are still at the discussion stage regarding general upgrading of the building to offer a more suitable environment for the generation of older people now coming into care. Some residents who require a wheelchair to mobilise find the size of the smaller rooms restrict full use and not all of the en-suites have a washbasin in the en suite. The main house is sited in grounds which offers access to smaller patios and a grassed area. A resident said how they liked the patio and enjoyed sitting out there. The slope of the site offers good views over Dunorlan Park and the surrounding countryside. A well respected maintenance person is employed, residents appreciate his help is personalising their rooms and his prompt response to any requests. Each resident has their own bedroom, which whilst in the main is not large, has an en-suite, bed, clothes storage and easy chair. Residents may bring with them small personal items, there is limited room for larger items of furniture. Most permanent residents have rooms which are well personalised, many mentioned how much they appreciated this. A room key can be provided on request, each room has a lockable unit. Over the past few years improved bath and shower arrangements have been made giving a range of facilities to meet individual needs and choices. Bathrooms are risk assessed for safe use. Plans have been presented to upgrade two bathrooms where the bath is against the wall and pose a moving and handling risk. Each room has its own ensuite, the majority have a washbasin in the ensuite, others have the basin in the sleeping area. Additional toilets are provided on each floor and accessible from communal areas. Staff have their own designated area and facilities. At some significant expense each room has been provided with an adjustable bed and pressure relieving mattress. Additional aids and equipment as required is either provided by the home or obtained through local health sources. Hoists have been purchased which are easier to use and which can weigh residents whilst being hoisted. A good sized lift gives access to all areas used by residents. The nurse call system has recently been replaced by a radio linked system which can indicate where the call is being made and record the time taken to respond. Individual preferences regarding room temperature and fresh air are managed by thermostatically controlled safe surface radiators and windows with restrictors. Residents are further protected from risk by monitoring of hot water at outlet. Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 19 Residents considered the home was generally clean and mainly odour free. One relative again felt that the standard of cleanliness could be better. Waste which might present a health and safety risk is removed safely. A large designated laundry room is sited on the ground floor. Great care is taken to reduce any risks of cross infection and to ensure that residents’ clothes are well looked after and returned to them promptly. Following the installation of a new washing machine and tumble drier, the laundry floor needs repair to better reduce the risks of cross infection. Dry cleaning can be arranged at additional cost. Residents considered the laundry service was very good. Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents are cared for and supported by properly recruited and trained staff which would be better evidenced by small improvements to recruitment practices. EVIDENCE: Halliwell is staffed by qualified nurses and care staff who work on roster to provide 24 hour care. Both planned and actual hours are recorded on the roster. At all times at least two registered nurses are on duty. The management structure consists of a General Manager, clinical care manager, team leaders, registered nurses, nursing assistants and care staff. On each shift, staff are allocated to work on either Constance or Elizabeth floors, many normally work on one or the other floor to provide continuity of care. The home is staffed in part in response to need and occupancy levels. Staff considered that ‘it was hard work’ and there were times when they wished they had more time to chat to residents. Contract staff carry out catering, laundry and cleaning so care and nursing staff can focus on direct care and support. Residents like the staff, they find them approachable, polite and kind. They appreciate the named nurse and keyworker system which includes a named night nurse. Relatives find staff ready to listen to any comments and think the communication book useful. Staff said it is helpful to get to know residents better through the keyworker system and how this links up to care planning. Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 21 A member of staff felt that ‘morale was good, staff worked well as a team, they worked hard and provided residents with excellent care’. Staff felt that training was very good. One more recently recruited member of staff said she had ‘lost count’ of the courses she had been on, but how useful she found them. She thought training was excellent especially compared to other homes she had worked in. Halliwell is proactive in ensuring staff obtain NVQ qualifications. One person is responsible for taking staff through their NVQ and to provide supervision. Staff who obtain NVQ qualifications are rewarded in the pay scale, carers who achieve NVQ 3 may apply for a nursing assistant post. Other training is offered including core training, mandatory training, client specific and personal development. Lists of future training courses were seen on the notice board, clearly indicating which were mandatory courses. Qualified staff are supported to maintain their nurses registration. A training matrix is held. All staff follow a recorded induction process which includes time spent shadowing other staff. Staff confirmed they had had a good induction, one person considered her mentor was so good she had sent her a thank you card. The General Manager has introduced a ‘welcome to Halliwell’ book for all staff which includes key information and the induction record. Staff are given responsibility for areas such as health and safety, infection control and moving and handling and are expected to ensure residents are assessed and staff trained in these areas. A designated training room is available. Records show that staff are properly recruited, with minor exceptions, and have the knowledge and attitude necessary to care for older people. Qualification documentation is checked together with evidence of current nursing registration. Evidence from others is obtained to check previous employment history. The application form gives provision to record the reason for leaving work with vulnerable people. Telephone checks are made as necessary. A declaration of health and fitness to work is set out as part of the application form, in one case this hadn’t been completed however the member of staff had signed a ‘fitness to work at night’ declaration. Qualified staff are required to complete a ‘competence to administer medication’ test. Staff have contracts of employment and receive copies of the General Social Care Council code of conduct. Staff, volunteers and visiting personnel such as the hairdresser and chiropodist have satisfactory criminal records bureau certificates. Where in exceptional circumstances a person starts work before the criminal records bureau certificate has been returned a POVA check is carried out and a printout held. This had not been done for an overseas member of staff however this person had been working supervised at all times during his induction. Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Residents benefit from a clear management and organisational structure which recognises the expectations of older people needing nursing care. EVIDENCE: Residents can be assured that the staff structure of the home provides clear designated responsibilities for overall and task specific management. Those staff in positions of responsibility have the experience and qualifications necessary for their roles including a registered nurse status or NVQ 3. The organisational structure gives upper lines of accountability with the General Manager holding direct day-to-day responsibility for Halliwell. A member of staff said that Halliwell was a ‘well managed home, we do things correctly and have the proper equipment’. Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 23 The General Manager has built up a strong team who work effectively. Staff were clear that the final judgment over day to day matters were those of the General Manager, but within this structure held areas of designated responsibility such as heath and safety, tissue viability and falls management. Staff responded to the opportunities to take these responsibilities and the freedom to use their initiative to provide a good service. All staff are expected to work in a professional manner, action will be taken where performance does not meet expected standards. External management training was recently held over two days for staff in managerial positions. They felt that the training was excellent and helped the team to work even more effectively. Relatives felt they had people with whom they could discuss care of their family member. One person confirmed that if there were any problems they would be contacted promptly. Quality assurance is taken seriously with excellent formal and informal mechanisms for obtaining the opinion of users of the service, professionals and associated personnel and for general monitoring of standards. Where standards fall below acceptable levels, an action plan is set up with timescales by which action must be taken. Monthly visits by a representative of the organisation take place with a report produced. Results of the quality assurance process are published and summarised in information for residents. Regular meetings are held including residents meetings, staff and Heads of Department. Minutes of such meetings are available as necessary. The Trust ensures the continued viability, financial support and investment into services. Systems are in place for residents to have money held safely if they wish with records maintained. Proper insurance cover is taken out to protect residents and staff, detail of which is included in the ‘Welcome to Halliwell’ booklet. Staff receive regular supervision from the NVQ coordinator who staff say is supportive and enabling. Those who are not undertaking NVQ training have group supervision. Following discussion with the General Manager additional one to one planned supervision will be introduced. Records management has improved to ensure they meet regulatory requirements and are presented in a professional manner. Residents are aware that they have the right to see information held about them, although few choose to do so. Records maintain confidentiality and the principles of data protection. The safety of residents, staff and visitors is respected and promoted through good health and safety practices. Risks from fire are reduced through recorded monitoring of fire safety systems and staff training. Regular fire practices and drills are held. Staff who do not attend mandatory training are Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 24 subject to management action. Certain staff have taken ‘training the trainer’ courses and as part of their delegated responsibilities run training sessions and ensure all staff are up to date with training such as moving and handling. Regular servicing of equipment and a responsive approach to deficits provides residents with a comfortable and safe place to live. Relevant legislation is complied with and policy statements are available to all staff. Accidents and incidents are recorded properly and notified to the appropriate bodies where necessary. An evacuation procedure has been set up with systems to offer protection in situations of high risk. During the recent heatwave policies were set up for each floor to reduce the risk to elderly people. Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 3 18 4 3 3 2 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 3 3 2 3 3 Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP21 OP26 OP29 OP29 OP36 Good Practice Recommendations A washbasin should be provided in each en-suite facility. This remains a recommendation from previous inspections The laundry floor should be repaired to better reduce the risks of cross infection That staff are suitable to work with vulnerable adults will be better evidenced when POVA checks are consistently carried out when required. That staff are suitable to work with vulnerable adults will be better evidenced when health declarations are reliably completed. Effective working will be better monitored if the current supervision system were developed to include planned opportunities for one to one meetings Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Halliwell Nursing Home DS0000064706.V299253.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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